ATI MATERNAL NEWBORN PROCTORED EXAM 400 PRACTICE QUESTIONS WITH DETAILED RATIONALES

ATI MATERNAL NEWBORN PROCTORED EXAM 400 PRACTICE QUESTIONS WITH DETAILED RATIONALES 1. A nurse is caring for a client at 32 weeks gestation who is experiencing preterm labor. Which of the following medications should the nurse anticipate administering to enhance fetal lung maturation? A) Nifedipine B) Indomethacin C) Betamethasone D) Verapamil Answer: C) Betamethasone Rationale: Betamethasone is a corticosteroid administered to pregnant women at risk for preterm delivery between 24-34 weeks gestation to accelerate fetal lung maturity by stimulating surfactant production. Nifedipine and indomethacin are tocolytics used to stop preterm labor, while verapamil is a calcium channel blocker not used for this indication. ________________________________________ 2. A nurse is assessing a newborn 1 minute after birth and notes a heart rate of 136/min, respiratory rate of 36/min, well-flexed extremities, crying in response to stimuli, and blue hands and feet. Which Apgar score should the nurse assign? A) 7 B) 8 C) 9 D) 10 Answer: C) 9 Rationale: The Apgar score is calculated as follows: Heart rate 136/min (100) = 2 points; Respiratory rate 36/min (good cry) = 2 points; Well-flexed extremities = 2 points; Crying response to stimuli = 2 points; Blue hands and feet (acrocyanosis) = 1 point. Total = 9 points. A score of 9 indicates the newborn is in good condition. ________________________________________ 3. A nurse is providing teaching to a client who is 4 weeks postpartum and is breastfeeding. The client asks about expected weight loss. Which of the following responses should the nurse make? A) "Losing 2.2 pounds each month would be acceptable" B) "Losing 4.4 pounds each month would be acceptable" C) "Losing 5.5 pounds each month would be acceptable" D) "Losing 6.6 pounds each month would be acceptable" Answer: A) "Losing 2.2 pounds each month would be acceptable" Rationale: During breastfeeding, a gradual weight loss of approximately 2.2 pounds (1 kg) per month is considered safe and acceptable. Rapid weight loss can compromise milk production and maternal nutrition. Breastfeeding mothers require adequate caloric intake to support milk production. ________________________________________ 4. A nurse is assessing a client at 34 weeks gestation who has a mild placental abruption. Which of the following findings should the nurse expect? A) Increased platelet count B) Fetal distress C) Decreased urinary output D) Dark red vaginal bleeding Answer: D) Dark red vaginal bleeding Rationale: Placental abruption is characterized by dark red vaginal bleeding due to the separation of the placenta from the uterine wall. The bleeding is often described as "dark" because it is venous in origin. Pain is typically present, and the uterus may be tender or board-like. Fetal distress may occur but is not the primary expected finding in mild abruption. ________________________________________ 5. A nurse is caring for a client who is receiving magnesium sulfate for preeclampsia. Which of the following findings indicates magnesium toxicity? A) Respiratory rate of 12/min B) Reflexes 2+ C) Urine output of 40 mL/hr D) Serum magnesium level of 4 mEq/L Answer: A) Respiratory rate of 12/min Rationale: Magnesium toxicity is indicated by a respiratory rate of less than 12 breaths per minute, decreased deep tendon reflexes, and oliguria (urine output less than 30 mL/hr). A respiratory rate of 12/min is at the threshold and should be monitored closely. Reflexes of 2+ are normal, and a serum magnesium level of 4 mEq/L is within therapeutic range (4-7 mEq/L). ________________________________________ 6. A nurse is caring for a client who is in labor and has received epidural analgesia. The client's blood pressure is 88/50 mmHg, and the fetal heart tracing shows late decelerations. Which of the following actions should the nurse take? A) Assist the client to the bathroom to empty her bladder B) Increase the rate of the primary IV infusion C) Position the client in a semi-Fowler's position D) Provide glucose via oral hydration or IV Answer: B) Increase the rate of the primary IV infusion Rationale: Hypotension following epidural placement is a common complication caused by sympathetic blockade. Increasing IV fluid infusion helps restore blood pressure and improve uteroplacental perfusion, addressing the late decelerations. The client should be positioned on her side to avoid supine hypotension, not in semi-Fowler's position. ________________________________________ 7. A nurse is assessing a client who missed 2 menstrual cycles and reports that she might be pregnant. Which of the following findings is a positive sign of pregnancy? A) Quickening B) Breast tenderness C) Uterine enlargement D) Auscultation of a fetal heart rate Answer: D) Auscultation of a fetal heart rate Rationale: Positive signs of pregnancy are those that can only be attributed to the presence of a fetus and include auscultation of fetal heart tones, visualization of the fetus on ultrasound, and palpation of fetal movements by an examiner. Quickening (fetal movement felt by the mother), breast tenderness, and uterine enlargement are presumptive or probable signs. ________________________________________ 8. A nurse is caring for a client who is 2 hours postpartum and is exhibiting signs of hypovolemic shock. Which of the following actions should the nurse take? A) Saline lock the IV catheter B) Provide oxygen via nasal cannula C) Elevate the client's legs to a 30° angle D) Place the client in a semi-Fowler's position Answer: C) Elevate the client's legs to a 30° angle Rationale: Elevating the legs to a 30° angle (modified Trendelenburg position) helps promote venous return and improve cardiac output in a client experiencing hypovolemic shock. The IV should remain open, not saline locked. Oxygen should be administered via non-rebreather mask, not nasal cannula, for maximum oxygenation.